Table 3.
Characteristics of the studies related to the effectiveness of Medical Nutrition Therapy on glycemic control in adolescents with type 1 diabetes.
| Author | Sample size | Age of participants | Intervention | Outcomes | Findings |
|---|---|---|---|---|---|
| Randomized Clinical Trials | |||||
| Dłużniak-Gołaska et al. [16] |
N = 70 intervention with interactive methods and education (group E) N = 81 intervention with education without interactive methods (group C) |
8–17 years | Interactive methods, i.e., quiz + multimedia application |
HbA1c Insulin dose |
HbA1c (%): mean change (95% CI): − 0.47 (−0.77; −0.17), P < 0.01 in the group E; p = 0.038 for the intergroup difference after 3 months. However, no significant changes within groups after 6 months of treatment. Insulin dose (U/Kg BW/d): mean change (95% CI): 0.07 (0.02;0.13), p < 0.05 in the group E. |
| Nansel et al. [17] |
N = 66 intervention N = 70 control |
8–16 years | Behavioral nutrition intervention to increase whole plant foods | HbA1c | HbA1c (%) (mean (SE) = 8.3 (0.1) intervention group vs. 8.2 (0.1) control group); p value was not different between both groups. |
| Göksen et al. [18] |
N = 52 intervention N = 32 control |
7–18 years | Carbohydrate counting |
HbA1c Insulin dose |
HbA1c (%) (mean (SD) = 8.76 (1.77) for the control and 7.87 (1.38) for the intervention group, p = 0.010). Insulin dose (U/Kg/d) (mean (SD) = 1.02 (0.31) for the controls and 1.01 (0.28) for the intervention group, p = 0.643). |
| Spiegel et al. [19] |
N = 33 intervention N = 33 control |
12–18 years | Carbohydrate counting | HbA1c | Mean (SD) = −0.19 (0.12) for intervention group and −0.08 (0.11) for the control group; p = 0.49. |
| Marquard et al. [20] |
N = 9 OMD group N = 8 low-GI group |
6–14 years |
Two groups: - Optimized mixed diet - Flexible low-glycemic index diet |
HbA1c |
OMD group (mean (SD)): HbA1c (%) = 7.4 (0.6) at baseline and 7.3 (0.5) at follow-up; p = 0.44 Low-GI group (mean (SD)): HbA1c (%) = 7.0 (0.5) at baseline and 6.9 (0.5) at follow-up; p = 0.61 |
| Gilbertson et al. [21] |
N = 38 CHOx group N = 51 low-GI group |
8–13 years | Comparison between the CHOx with low-GI |
HbA1c Incidence of hypoglycemia and hyperglycemia Insulin dose |
HbA1c (%): CHOx group vs. low-GI group (mean (SD) = 8.6 (1.4) vs. 8.0 (1.0), respectively; p = 0.05). Insulin dose (UI/Kg): CHOx group vs. low-GI group (mean (SD) = 1.0 (0.3) vs. 1.1 (0.3), respectively; p = 0.87). Episodes of hyperglycemia (mean number per month): CHOx group vs. low-GI group (mean (SD) = 16.8 (11.8) vs. 11.2 (9.8), respectively; p = 0.06). Episodes of hypoglycemia (mean number per month): CHOx group vs. low-GI group (mean (SD) = 5.8 (5.5) vs. 6.9 (6.8), respectively; p = 0.37). |
| Donaghue et al. [22] |
N = 12 intervention N = 11 control |
14–21 years |
MUFA-rich diet: 43% of fat, 20% of MUFA. Control group: 30% of fat, 55% of carbohydrate |
HbA1c Insulin dose |
HbA1c (%) (median [IQR] = 8.8 [8.2–9.5] for the intervention group vs. 9.3 [8.0–10.4] for the control group; p = 0.80). Insulin dose (UI/Kg) (mean (SD) = 1.0 (0.2) for the intervention group vs. 0.9 (0.2) for the control group; p = 0.70). |
| Hackett et al. [24] | N = 119 families | Mean (SD): 11.4 (3.3) of the younger group, and 12.4 (3.6) of the older group. | MNT | HbA1c | In adolescents under 11 years, no changes in HbA1c were observed. In adolescents over 11 years, an improved HbA1c was observed (p = 0.02). |
| Post-hoc from RCT | |||||
| Nansel et al. [35] |
N = 66 intervention N = 70 control |
8–16 years | Behavioral nutrition intervention to increase whole plant foods |
HbA1c 1.5-AG BG values MAGE |
HbA1c (%) vs. HEI-2005 and WPFD: β (SE) = 0.003 (0.003), p = 0.36 and −0.03 (0.03), p = 0.27, respectively. 1.5-AG (µg/mL) vs. HEI-005 and WPFD: (β (SE) = 0.004 (0.008), p = 0.62 and 0.16 (0.08), p = 0.05, respectively). Mean of BG values vs. HEI-2005 and WPFD: β (SE) = −0.41 (0.15), p = 0.005 and −4.35 (1.60), p = 0.006, respectively. MAGE vs. HEI-2005 and WPFD (β (SE) = −0.59 (0.20), p = 0.003 and −6.74 (2.14), p = 0.002, respectively). |
| Pre-post intervention | |||||
| Marigliano et al. [36] | N = 25 participants | 7–14 years | Carbohydrate counting with standard nutritional education |
HbA1c Insulin dose |
HbA1c (%) (mean (SD) = 8.50 (0.77) at baseline and 7.92 (0.74) at follow-up, p < 0.001). Insulin dose (IU/Kg/d) (mean (SD) = 0.80 (0.21) at baseline and 0.78 (0.18) at follow-up, p = 0.411). |
| Cadario et al. [37] | N = 64 participants | 13–19 years | Nutritional education according to the American Diabetes Association recommendations |
HbA1c Insulin dose |
HbA1c (%) mean (SEM) = 8.3 (0.1) at baseline and 8.2 (0.1) at follow-up; p was not statistically significant. Insulin dose (UI/day): mean (SEM) = 44.8 (1.9) at baseline and 50.6 (1.8) at follow-up; p < 0.001. |
| Lorini et al. [38] | N = 36 participants | 9–21 years | Intensive MNT |
Insulin dose HbA1c Lipid profile |
HbA1c (%) (mean (SD)): 10.6 (2.6) vs. 10.9 (2.6); p was not statistically significant. Insulin dose (U/Kg/d) (mean (SD)): 0.98 (0.33) vs. 0.98 (0.34); p was not statistically significant. |
BG blood glucose, BMI body mass index, CHOx traditional carbohydrate-exchange dietary advice, CI confidence interval, HbA1c glycated hemoglobin, HDL high-density lipoprotein,HEI-2005 Healthy Eating Index-2005, IQR interquartile range, KomPAN questionnaire for the study of views and dietary habits, LDL low-density lipoprotein, low-GI flexible low-GI dietary advice, MAGE mean amplitude of glycemic excursions, MNT medical nutrition therapy, MUFA monounsaturated fatty acid, NKS Nutrition Knowledge Survey, OMD optimized mixed diet, 1.5-AG 1.5-Anhydroglucitol, SE standard error, SD standard deviation, WPFD whole plant food density.